Endometriosis in the Lumbar Plexus Mimicking a Nerve Sheath Tumor

Sunil Jeswani, Doniel Drazin, Ali Shirzadi, Xuemo Fan, J. Patrick Johnson

Abstract


Endometriosis consists of ectopic endometrial tissue outside of the uterine cavity. It is typically benign; however, in some cases, it may cause neurological symptoms if involving the central or peripheral nervous system. We present in this report a 46-year-old Caucasian female with lumbar pain progressively worsening for the last 3 years in her left hip and buttock with radicular symptoms radiating to her left anterior thigh with MR imaging showed an enhancing mass in the L4 neural foramen, interpreted as a nerve sheath tumor. At operation the nerve showed extrinsic and intrinsic abnormality, proven to be endometriosis. Postoperatively, the patient reported relief from her radiculopathy. We review the previous cases, discuss the pathogenesis and additional characteristics that highlight that intraspinal endometriosis, although rare, and must be considered as a potential cause of lumbar pain in women. Surgical resection is recommended in cases having severe or worsening neurologic symptoms or signs of cauda equina syndrome but care must be taken to avoid injuring the nerve. Adjunctive treatment may be used in cases of residual or recurrent lesions.




doi:10.4021/wjon413w


Keywords


Endometriosis; Nerve root; Synovial cyst; Lumbar radiculopathy; Woman; Cyclical

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